You’ll just have to take my word for this part.
I changed physicians recently because my former doc thought that I had a disease from deer ticks. We live in a heavily wooded area with lots of deer and I was feeling what I thought was the aches and pains of over-exercising an aging body. My physician knew otherwise. She had uncovered evidence of an epidemic from deer ticks, yet the authorities were not taking her seriously, like she was one of the good guys in the X-Files. I found a new physician, changed my workout routine, and my aches and pains disappeared. The deer, and presumably their ticks, remain.
On my last visit to my new physician, I noticed what you’ll now have to accept as true based solely upon my testimony. She recently moved locations from a nice small suburban mall building to a newly renovated former beauty and spa building. As I entered the very nice building for the first time I noted a small red sign by the door that tells Drug Reps to not park in the main parking lot. Then, as I proceeded into the entrance, I observed that it is actually a double entrance – you go through two sets of doors. The area between the two sets of doors is arranged with chairs as an exterior waiting room for, you guessed it, Drug Reps. Another sign directs them to sit there.
Thus, the first message my new physician sends to her clients is about Drug Reps. And, she makes sure that if any are present that you will see them before you see her. Now, my physician is a very sweet and nice woman who is polite, thorough, and absolutely clueless about social perception, persuasion, and impression formation. I’ve only had two face to face interactions with her, the first when I changed physicians and the second when I had a regular check up. Both times she advised me to take a statin for cholesterol even though I am healthy. Both times she offered to write a prescription for a brand name drug rather than a generic.
Knowing nothing about me and thinking only about the proven effects of drugs, a reasonable reader should note two concerns. First, statins, the cholesterol lowering wonder drugs, have no benefit for healthy people. Second, generics work as well as branded drugs and cost considerably less. Yet, my sweet physician is recommending drug actions for me that I don’t need, won’t work, and will cost more money than necessary, if the drugs were necessary. And, by the way, if you’re a Drug Rep, park over there and sit here.
Let me tie this little example to the broader case. The lede makes the point.
A dozen pharmaceutical companies have given doctors and other healthcare providers more than $760 million over the past two years – and those companies’ sales comprise 40 percent of the U.S. market.
The source of this claim is from a public watchdog group, Pro Publica, which is assembling a database of pharma reports on these transactions. Realize we are not talking about payments for prescribing pills. These payments go for other services beyond writing script. Now, payments from pharmas to physicians for a variety of services is as old as pills and people, but these transactions were never reported. New Federal law requires this starting in 2013 and some pharmas have gotten ahead of the curve (as you should with bad news – Inoculation, baby) and are posting these documents early which is how Pro Publica got them.
How can we understand this $760 million payout for consulting, speaking, research and expenses to physicians? Well, there are approximately 700,000 physicians in the US. Each year, it appears, these reporting pharmas gave about $380 million. That works out to about $500 per physician. And, of course, this is data from pharmas with 40% market share. It’s not unreasonable to assume that the unreporting pharmas with the remaining 60% of market paid out at a similar rate, so as a rough estimate, the average physician gets about a thousand dollars a year from pharmas in direct payments for services beyond simply prescribing pills.
If this was a 1950s story about illegal union activity among dockworkers and stevedores, you’d call this a kickback. You’d make the movie in black and white with Marlon Brando, call it something like On The Waterfront, and make a classic. Here we just call it Health Care Reform We Can All Believe In. Docs get paid to prescribe drugs, more for branded and less for generic, in direct payment from insurance companies. And, they also get paid by pharmas in the form of payments for research, speaking, and consulting.
I’ve already narrated my one experience with consulting for a pharma here. It was essentially a paid vacation that got called work. Not illegal by any means, but certainly not serious work either. Melanie accompanied me, enjoyed herself enormously on a white beach while I worked in a beautiful air-conditioned resort hotel conference room, and, yes, they also served prawns on the buffet line. It’s a dirty job, but when she’s happy, you’re happy.
This is a commonplace example of physician services that pharmas buy. Whether in San Juan or the nicest restaurant in town, whether as consultant, speaker, or evaluator, the pharmas pay the freight for an enjoyable bit of effort. Not exactly a seminar with pizza and pop – pop is a poor pairing with prawns; try the Chardonnay instead.
Now, let’s make a big pivot. If you spend anytime reading health and medical research journals, you know how sensitive the community is to money. You might recall Marion Nestle’s triumphant dismissal of a study because they got funding from a commercial food company. That’s a standard response. Hey, if commercial sources are paying for the research, the research is biased. Nestle’s axiomatic, knee-jerk, Ding Dong response is emblematic, common, and widespread in the health and medical community.
However, when physicians or researchers get paid by commercial sources to consult in San Juan in February, it’s okay. No bias here. You can’t buy a physician for a grand.
Of course, as a persuasion maven you know that’s true. You can’t buy a physician for a thousand bucks. You own them.
The persuasion plays here are so obvious they are comical. Pharmas employ small incentives with the Other Guys. These incentives have many different functions. Sometimes the incentives work as consequences that produce immediate positive affect and benefits (San Juan, the prawns, and Melanie in her little blue bikini). Sometimes the incentives produce insufficient justification for the physician’s unethical action which produces dissonance and the drive for reduction which usually resolves into innocence, charity, and increased script writing. Sometimes the incentives buy reception, processing, and response as the pharma Cascades the physician into a new drug. Of course, this isn’t funny, because your health and wallet are the punch line.
Now, walk with me to the entrance of my physician’s office. See that red sign telling Drug Reps to park there. Then enter that little exterior vestibule with seats and a sign telling Drug Reps to sit here. Then meet my sweet, polite, and thorough doc who wants to write script for a drug you don’t need, won’t work, and costs more.
But, she wasn’t bought. Even she will tell you that.
There’s a Difference between Persuasion, and Smoke and Mirrors; with Persuasion the Illusion Lingers.
P.S. It appears that the pharma guys are getting their groove back since the bad times after the 1999 party. Brilliant persuasion. Now, invent a pill that makes my knees work like they did when I was 40, not even 20, 40 would be good. And, if the side effects include an erection lasting longer than four hours, that’s just the price somebody’s gotta pay for good knees. Let’s party like it’s 1999 (YouTube).
P.P.S. I stopped running so flat footed and got up on my toes and the balls of my feet. No more joint problems. Even in my shoulders and elbows. Considerably less back pain. Of course, I look like a ballet dancer prancing down the road. No wonder everyone waves at me. Jeté, Etienne, jeté!